Are You Infected With A Hospital-Centric Meme?

Physicians are certainly well acquainted with the concept of nosocomial infections, infections acquired by patients during the course of hospitalization and infections acquired by hospital personnel.

But physicians are for the most part unaware of another type of infection relating to hospitals: the meme, or mind virus, an accepted cultural idea or paradigm, infecting physicians in respect of the issue of healthcare itself: I’m talking about the mind virus of hospital-centric healthcare.

There is no legitimate reason, other than a grab by hospitals for control, why hospitals and their vehicles, such as accountable care organizations (ACOs) should be favored over physicians as the hub of the healthcare environment. In fact, the tremendous advances in technology resulting from the microchip revolution means that authority can be distributed among a broader segment of participants; in this case, physicians.

There is no need to “align” physicians with hospitals financially in order to align in terms of information and coordination of care.

So why do you believe there is?  Submit a comment or contact me if you’d like to discuss your response.

Mark F. Weiss

The Promise-Delivery Gap

You’ve probably heard the admonition to under promise and over deliver.

But what happens if you habitually over promise and under deliver? And what if it’s a central part of your business plan?

It’s become painfully obvious to subsequently disgruntled medical staff members and to subsequently terminated senior hospital administrators that the so-called national anesthesia and national radiology groups are incredibly adept at promising the world, but they often deliver less than a few square yards. I call this The Promise-Delivery GapTM.

Take this recent example:

An all Board Certified, all M.D. anesthesiology group is locked in an RFP battle. The competition: a so-called anesthesia management company, with no existing physician or CRNA personnel available, but full of promises – world class this, best-practices that, and outstanding providers, too! All that they were missing, in their viewpoint, was the demand for any stipend support, which of course clinched the deal for them.

So far so good.

A few months into the new contract the hospital was in disarray. Their Medicare certification was lost, but then regained. A rotating crop of locums providers passed through the facility — few of them stuck around or were even asked to. The hospital’s new cardiac program, on which it spent millions recruiting a new surgical team and building out its facility, wasn’t able to function due to the lack of cardiac anesthesia coverage – it took almost 6 months to do their first cardiac case.

And, the senior administrator who championed bringing in the new group due to the supposed cost savings that would result suddenly departed — the spin: that she had left to pursue other opportunities; the reality appears to be far different.

This is the central weakness of the so-called national groups. All image, but little substance. All hat, but no cattle. All promise, but little delivery.

Take advantage of it.

Contact me if you’d like to discuss this post.

Mark F. Weiss

The Super Bowl and Medical Group Success – Podcast

Did you notice that the Super Bowl was all about medical group success?

Why Let Your Competitors Control Your Future?

Why is it that some group leaders believe that simply having data on what their competitors might offer in terms of exclusive contract stipends, depth of coverage, and the like weighs heavily on their group’s own future?

This is incredibly limiting thinking.

Consider the example of car manufacturers. Certainly, there are commodity manufacturers, such as Chrysler. Those manufacturers are indeed concerned with their competitors’ pricing and features. Taken together, those manufacturers spend billions trying to convince you that a Dodge Ram is better than Chevy Silverado, and vice versa.

But then there are manufacturers like Lamborghini and Ferrari. They are competitors in an entirely different sense. Each produces cars aimed at a different segment of a very particular market. But even then, Lamborghini makes cars and chases buyers, while Ferrari won’t even make a car to ship to a dealer unless that dealer already has it sold.

On even a basic level, knowing exactly what your competitors have accepted as stipend support at other facilities doesn’t provide any truly useful information in respect of what the stipend should be at your facility. Averages are even more useless.

On a deeper level, believing that what your competitors might offer somehow controls your decision as to what you’re going to offer allows your competitors to tell you how to run your business.  Why not make it simple and just call them up and ask them what kind of response to the RFP you should submit?

The key is to turn the tables on the creeping commoditization of your specialty before you get to the RFP. Sell Ferraris, not Chevys. And if the hospital only wants to buy Chevys then you’re practicing at the wrong location. But that’s another story.

Mark F. Weiss

Align or “A Lyin’?”

Physician alignment is all the rage. But of course, as I’ve written before, hospitals use the line “align” when they’re actually a lyin’ to you. That is, unless the meaning of the word align actually is “to control.”

However, as is the case with much propaganda, there is a kernel of truth within the concept of alignment that physician group leaders must pay heed to: this is the fact that groups must actually align their delivery of service and the larger experience they provide to hospitals, referral sources, and patients with those parties’ needs; in fact, done right, that alignment should exceed their expectations.

This is not a difficult concept. However, it’s a concept that nearly every one of your competitors misses.

Stop making it so hard for you to succeed.

Mark F. Weiss


Shadowing The Competition – Podcast

Someone’s strategizing to take over your practice; it might as well be you.

Medical Group Termites

Perhaps you’ve carefully structured your medical group’s relationships with hospitals, referral sources and other influencers. But did you pay attention to what’s going on inside your practice’s own house? Have you built a wonderful structure that’s being eaten up from the inside out by the group member equivalents of termites and wood rot?

It’s my experience, and it’s becoming an increasingly regular experience, that medical groups fail more often from problems within the group as opposed to solely from competition or as a result of attacks from outside of the group itself.

These problems range from group members whose misfeasance or malfeasance bring disrepute, to group members who engage in malicious activity outside of the pure scope of medical practice, to group members who actively consort with the hospital or a competitor to destroy or co-opt your practice.

None of the protections that are normally built into relationships between groups and outside parties are aimed at protecting the group from these internal risks.

To do so requires a different series of approaches starting with screening potential group members, whether employees or owners, on personality and interpersonal attributes as well as on medical expertise. It requires carefully evaluating, and not just on an annual review type basis, the members of your group and disciplining, or if required, terminating the “termites” before they destroy your group. It requires an entirely different set of protections built into your group’s internal documents, your shareholders or partnership agreements, employment agreements and subcontracts, in order to protect against more than what even those groups who are “benchmark to best practices” consider relevant. And it requires a coordination between those internal actions and the group’s relationships with hospitals and other facilities.

One disgruntled or malicious physician can destroy your $50 million a year business. Preventing the problem presents one of the best returns on investment you’ll ever receive.

Mark F. Weiss

Is Your Medical Practice A Social Service Or A Business?

Is your practice a social service or is it a business?

These are two entirely different goals and if a definitive answer doesn’t immediately pop out of your mouth you’re in trouble. A dog may have four legs, but it can only walk in one direction at a time.

Today, with the communal notions of the “We” society in full swing, physicians are, in essence, being told by politicians, pundits and the press that you are in social services: They don’t see a healthcare market; they see a healthcare system, one that exists to serve the public, a significant portion of which believes that healthcare is a right and that it should be as free as air — or at least free to them . . . the “rich” should pay for it.

Of course, not everyone that says this believes it. Some say it just to get votes. Some say it just to get free stuff. And hospitals that want to herd you into an ACO or want to employ you at bargain basement (oops, I mean fair market value) compensation tell you that you need to economically align with them in order to deliver quality care to the public —  that’s our mission, isn’t it?

Now I’m not saying that you should not be focused on delivering quality care, but you first have to make the decision if, for you, you’re doing this as a viable business in which you have control over your future or whether you’re doing this as a cog in the wheel of the healthcare factory run by the hospital or the government.

If it’s the former, then you need to become much more active in conducting your practice as a business, both in order to compete with the large groups operating in many of the medical specialties which absolutely operate as businesses, as well as to push back against the trend toward the socialization of healthcare.

There is another alternative of course, there always is. And that’s that as opposed to going back to school, as so many physicians did, to get MBAs to understand how to run practices in the face of managed care, perhaps you should go back to school and get a masters in social work.

Mark F. Weiss

Physicians Must Brand Their Role in Healthcare – Podcast

As hospitals quicken their pace to replace physicians with paraprofessionals, physicians must brand their role in healthcare or suffer the consequences.

St. Bully Medical Center


We’re not talking Teddy Roosevelt, we’re talking intimidation.

There’s been a lot of talk about bullying of hospital staff by physicians and even of bullying by nurses of junior staff and of younger physicians.  Hospitals, through their personnel function, and medical staffs, by way of medical staff discipline and physician wellbeing, are expected to police this behavior.

But what about hospitals that tolerate or even institute cultures of corruption, cultures that incentivise nurses and other staff members to intimidate physicians through incident reports that are judged administratively, outside of medical staff due process?

As the relationship between physicians and hospitals becomes more strained due to hospital-centric notions of healthcare, hospitals are becoming more coercive in thinning the medical staff ranks of independent physicians and twisting arms in order to get the other arms voting for closer “collaboration.”

Mark F. Weiss